Shining a light on women’s health and safety issues

The inaugural Auroville Women’s Health Survey aimed to capture a snapshot of the health of Auroville women in the areas of puberty, sexual health, maternity and personal safety. Led by Paula, a nurse-midwife at Santé and a women’s health nurse practitioner with 30 years experience, the exploratory research aimed to better understand aspects of women’s lives in Auroville and to gain a more precise understanding of her field.

“I wanted to shine a light on areas of life that are taboo for some women and cultures, specifically menstruation, sexual health, maternity and personal safety,” says Paula, emphasizing that these are the areas in which she is qualified to provide services and advice, and where she would like to make changes. “These subjects are shrouded in mystery, ignorance, and unspoken codes of conduct in cultures around the world. I wanted to investigate and find out the truth of things I heard, the cultural norms, the deficits in education. It’s an incredibly diverse international community, so people have different culturally-influenced expectations about health care.”

In collaboration with women working in related fields in Auroville and a research intern from Holland, Paula devised 28 key questions and protocols to administer the survey. Financial support was provided by SAIIER, and in-kind support was given by Santé and Eco-Femme. 218 Aurovilian women aged 15 and above took part in the survey – about 20% of Auroville’s female population in this age range. Respondents included non-Indians, Indians from the Auroville bioregion and Indians from elsewhere – a demographic spread in age and ethnic proportions that accurately represented the population of Auroville. “This gives us the confidence to say that our research findings are an accurate reflection of the population of women in Auroville at this time,” says Paula.

The survey was completely anonymous and confidential. In order to ensure equitable participation and a representational demographic spread, the team made special efforts to reach Tamil Aurovilian women, for example, by providing a printed Tamil language version and holding sessions at Life Education Centre, where the staff explained the questions for groups of participants. “I realized that there is some limitation to the Western survey method of a pencil and paper questionnaire,” says Paula. “I found that some participants really needed a lot of help to do this kind of questionnaire. Also I don’t know that they’ve ever been able to really answer some of these questions as a free agent.”

The responses for some questions were so often clearly differentiated according to cultural background, that the research findings are often presented in binary form: responses of women from the bioregion(Tamil Aurovilian women), contrasted with women not from the bioregion(Aurovilian women who are non-Indian or who are from other parts of India). Paula emphasizes that the survey is merely a snapshot of women’s health in Auroville at this time, and it does not investigate more complex issues relating to differing cultural norms about health. However, she hopes that the conclusions are sufficient to translate into action in the fields of education, health care, security services and public awareness, as well as to open up dialogue and raise awareness.

Research findings

The opening questions focussed on puberty, particularly how well prepared women felt before their first period. “I knew there is a ceremony in Tamil Nadu when girls have their first menstruation,” says Paula, “so I thought ‘Well then that must mean they’re prepared! They’re getting good education, they’re informed about the menstrual cycle, how you can get pregnant, how you keep yourself clean.’” However, this was not the case, as 94% of women from the bioregion felt unprepared (as compared to 81% not from the bioregion), which Paula believes is due to generational taboos, lack of information and discussion, and a cultural reluctance to approach women’s biology in a neutral way. Respondents expressed a number of needs in relation to periods, such as talks in schools, free period supplies, private toilets, and – as one woman stated – “education to understand that menstruation is not shameful”.

79% of all surveyed women said that sexual health care in Auroville did not meet their needs, but Paula believes this figure is influenced by respondents’ limited understanding of the terminology. “Some people didn’t like the term ‘sexual health’, because it must have different connotations in different countries,” says Paula. “In my world, sexual health care means everything from birth control to sexually transmitted disease – it is a huge field.” Yet she says that the response to this question spurs her dream – to offer services in Auroville that address women’s unique health needs without judgment.

More knowledge about sex required

80% of women not from the bioregion said they wanted to know more about sex which suggests “that they have enough self-awareness to know that there is much more to be known”, says Paula. In comparison, only 58% of women from the bioregion wanted to know more about sex. “I think that indicates that, for women from the bioregion, this is a taboo area, so if women know enough about what’s happening to get themselves through the situation, they are happy enough, but it’s very common that women wish that they knew more. Possibly women from the bioregion are less likely to recognise the deficit in knowledge than western women, and perhaps they would never ask. I’m hoping that the whole area of sexuality can become more freely discussed and not repressed.”

In relation to the first time respondents had sex, while the numbers of women from the bioregion and women not from the bioregion were largely aligned in being confident about their decision to have sex (37% and 34% respectively), there was a stark difference in motivation for first time sex: 19% from bioregion wanted to get pregnant, as compared to 1% of women not from bioregion. “Presumably, the majority of Tamil women having sex for the first time are doing it within marriage,” says Paula, “so it’s socially sanctioned sex and there’s a cultural imperative to produce a child as soon as possible.”

While women from the bioregion had a higher rate of feeling confident about their decision to have sex for the first time, they had a lower rate of giving consent (21% compared to 31%). “This was a point where I realized that we probably didn’t have the right tool to understand their story,” says Paula about the challenges of interpreting what lies behind data that’s collected across cultures. “And that was the big ‘take-away’ for me: this kind of questionnaire is not the most appropriate thing for the Tamil population. The question about consent probably required the most explanation for all respondents, as sexual decision-making is not cultivated across all cultures. These issues of being confident and giving consent, and using condoms or not using condoms, are all part of the intricate dynamics of a relationship and of sexual politics. This is not easily understood or dissected.

Also, we received direct comments from Auroville teenagers about feeling pressure to have sex as they approach the age of 16. Every day at school, peers ask them, ‘Have you done it yet?’ So there is peer pressure, and there are dissonances at that early point in life. For example, when a 14-year-old girl says she was confident and gave consent, but she didn’t use a condom or any other birth control, there you have a bit of a conflict because she may be giving consent, but is she giving consent to possibly getting a sexually transmitted infection or becoming pregnant? So there are complex dynamics around consent, and this survey has limitations in looking at that.”

The survey findings also identified that when respondents had what the researchers termed ‘early initiation of intercourse’ (defined by the World Health Organisation as below the age of 16), this was often followed by a “cascading effect of unwanted events”. For example, of the 18 women who had sex before the age of 16, 12 had an unplanned pregnancy, 11 were beaten, 9 felt raped, and four experienced all these events. “This seems to be linked to lack of awareness of sexual health issues,” says Paula, “but I can’t draw conclusions about that link, because this is really an exploratory study, and to pursue that link would require more specific research. But it was certainly a pattern, so we wonder what else was going on. Was it inadequate preparation, inadequate parental support or involvement in a young person’s life? Low self esteem?”

The rate of unwanted pregnancies was surprising to Paula – 26% of women from the bioregion, 50 % of women not from the bioregion – which Paula sees as a concrete indicator of inadequate education and health services.

Maternity issues

59% of respondents agreed that Auroville is a welcoming place for pregnant women, whilst 41% disagreed. Of 61 respondents who had children younger than 12 years old, a greater percentage of women from the bioregion were unhappy with their birth experience, compared to women not from the bioregion – which is possibly linked to the nature of hospital births in the area. Fewer women from the bioregion (44%) felt there was enough time for them and the baby, compared to 67% of women not from the Auroville bioregion. “There was such a discrepancy, that we really saw a very strong need to provide help to Tamil Aurovilian women giving birth,” says Paula, “because giving birth in a government hospital is a really abysmal situation. Women shouldn’t be faced with an over 50% risk of having a Cesarean delivery when they go into childbirth, they shouldn’t be delivering in unclean, unsafe environments. I would really like to help in the area of dignity in childbirth.”

Personal Safety

The topic of personal safety prompted much discussion at the public presentations of the research findings, as well as comments on the survey response forms. While 61 survey respondents said they had been abused or beaten, many women raised the issue of pervasive harassment, a question that the survey did not specifically ask. “Many comments came to us saying that harassment happens all the time, or ‘I wasn’t beaten, but I was grabbed’. Women have become so accustomed to being inappropriately touched and harassed that it gets difficult to see it because women minimize it.”

The survey found that in order to stay safe: women take longer routes home (120 women); travel in groups (90); store emergency numbers in their phone for Auroville security (80); or just don’t go out at night (80 women) – the latter being an approach to safety that, Paula points out, men are not required to take.

A survey question that posed a particular challenge for explanation to participants as well as interpretation of the data, was the one that asked if women had “ever felt raped”. As Paula explains, a question asking specifically if respondents ‘had been raped’ would have closed off responses from women, and she wanted to encourage women to express subjective experiences that included a profound sense of violation. “For example, one woman reported that a man in a train ejaculated next to her, but she would not report it as rape,” says Paula. “Another woman spoke of being violated by a doctor in a clinic, but she didn’t term it rape, because it didn’t involve penetration. So, we wanted to broaden respondents’ thinking and give them the opportunity to report different kinds of sexual assault, rather than rape that meets a legal definition.”

The question gained an affirmative response of 6% from women of the bioregion, and a much higher 25% from women from the non-bio region – the latter figure more closely reflecting WHO’s rates of rape of women worldwide. Paula believes the much lower number of 6% of women from the bioregion reflects how her survey “hits the six-foot wall of taboo”, where Indian women largely do not report or discuss rape. “Of all the women who get raped in India, only 30% speak to anyone about it, and of that only 1% report to the police. And yet everyone says, ‘We can’t do anything unless you’re willing to report it’, but reporting means you’re willing to go public, go to the police, have your name used, which has the consequence of losing your job, being ostracized from your family, and in some cases being forced to marry your rapist. Also, India does not recognise marital rape. So there, which is not reflected in the survey results, is probably a whole invisible group of people who might otherwise have determined that what they experienced was a violation and a rape.”

The survey concluded with the question, “Is there anything else you’d like to tell us?” This elicited a wide variety of responses. “One woman said that a light needed to be shone on abuse and incest, citing ‘alcohol abuse that leads to sexual forcing’”, says Paula. “I hadn’t asked specifically about incest but had heard it exists here, as in any place in the world.”

Presentation of findings

The response to Paula’s public presentations within the community have been highly supportive and positive, with many women and men approaching her to express their appreciation, to offer “cool ideas” and educational tools, or, in the case of Auroville’s security services, to emphasize their commitment to escorting women. “I have tried to present the findings in a format that’s not threatening, non-judgmental, and as something we can learn from.

At one presentation of the findings, a Tamil woman in the audience suggested that many Tamil women lack the terminology and never speak with each other about sexual health. Paula concedes that this is “a limitation” of the research. “The issue of the lines of communication – who speaks to whom about what, and what are the taboos – that’s very deep, and I don’t presume to have understood.”

Possible outcomes

The survey aims to be a small step in the direction of normalizing discussion around sexual health. “I hope that by shining a professional and academic light on it, I avoid making it salacious,” says Paula. ”The adults in the community have a responsibility to be frank and honest, and enlightened in their attitudes towards education of the youth, because there is no comprehensive sex education in Auroville. I would like to see every school in Auroville have ongoing sex education.” This education would ideally start at a young age, include accurate language for anatomy, and address issues of safety and safe touch, birth control, sexually transmitted diseases, emotional aspects of intimate relationships and decision making, and ways to minimize harm to self and others.” In an educational programme that I’ve done at TLC, I teach about making decisions that are based on values from within, that are harmonious and truthful to you and not being swayed by peer pressure or by a dominant personality – to learn to hear your own voice and to make your own decisions.”

Paula believes that the survey findings indicate a need for a health system and culture where sexuality is “much more open and not judged.” She would like to see a system that provides support to women after trauma and assault, where women are given the necessary emotional support, the emergency morning-after pill and screening for sexually transmitted infections. For maternity services, she would like to see the establishment of a birth center for women who might not want to give birth at home, but don’t want to give birth in a hospital. “One comment on the survey was, ‘We have a farewell center where we say goodbye to people, but how about a welcome center?’ I love the idea, so let’s work for it.”